Michigan PROCEDURES EMERGENCY AIRWAY
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ABCDE Approach
The ABCDE and SAMPLE History Approach Basic Emergency Care Course Objectives • List the hazards that must be considered when approaching an ill or injured person • List the elements to approaching an ill or injured person safely • List the components of the systematic ABCDE approach to emergency patients • Assess an airway • Explain when to use airway devices • Explain when advanced airway management is needed • Assess breathing • Explain when to assist breathing • Assess fluid status (circulation) • Provide appropriate fluid resuscitation • Describe the critical ABCDE actions • List the elements of a SAMPLE history • Perform a relevant SAMPLE history. Essential skills • Assessing ABCDE • Needle-decompression for tension • Cervical spine immobilization pneumothorax • • Full spine immobilization Three-sided dressing for chest wound • • Head-tilt and chin-life/jaw thrust Intravenous (IV) line placement • • Airway suctioning IV fluid resuscitation • • Management of choking Direct pressure/ deep wound packing for haemorrhage control • Recovery position • Tourniquet for haemorrhage control • Nasopharyngeal (NPA) and oropharyngeal • airway (OPA) placement Pelvic binding • • Bag-valve-mask ventilation Wound management • • Skin pinch test Fracture immobilization • • AVPU (alert, voice, pain, unresponsive) Snake bite management assessment • Glucose administration Why the ABCDE approach? • Approach every patient in a systematic way • Recognize life-threatening conditions early • DO most critical interventions first - fix problems before moving on -
TCCC CLS Skill Instructions Mod 7 25 JAN 20
MODULE 07: AIRWAY MANAGEMENT IN TFC SKILL INSTRUCTIONS 25 JAN 2020 COMBAT LIFESAVER (CLS) TACTICAL COMBAT CASUALTY CARE SKILL INSTRUCTIONS HEAD-TILT/CHIN-LIFT INSTRUCTION TASK: Open an airway using the head-tilt/chin-lift maneuver CONDITION: Given a simulated scenario where a casualty and responder are in combat gear and the casualty is unconscious without a patent airway STANDARD: EffeCtively open the airway by performing the head-tilt/chin-lift maneuver following all steps and measures correctly without Causing further harm to the Casualty EQUIPMENT: N/A PERFORMANCE MEASURES: step-by-step instructions NOTE: Do not use if a spinal or neck injury is suspected. 01 Roll the Casualty onto their back, if necessary, and place them on a hard, flat surface. 02 Kneel at the level of the Casualty’s shoulders. Position yourself at the side of the Casualty. 03 Open the mouth and looK for visible airway obstruCtions (e.g., laCerations, obstructions, broken teeth, burns, or swelling or other debris, such as vomit). NOTE: If foreign material or vomit is in the mouth, remove it as quiCKly as possible. NOTE: Do not perform a blind finger sweep. 04 PlaCe one hand on the Casualty's forehead and apply firm, backward pressure with the palm to tilt the head back. 05 PlaCe the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the Chin forward. NOTE: Do not use the thumb to lift the chin. 06 While maintaining the open airway position, place an ear over the casualty's mouth and nose, looking toward the chest and stomaCh. -
Airway – Oropharyngeal: Insertion; Maintenance; Suction; Removal
Policies & Procedures Title: AIRWAY – OROPHARYNGEAL: INSERTION; MAINTENANCE; SUCTION; REMOVAL I.D. Number: 1159 Authorization Source: Nursing Date Revised: September 2014 [X] SHR Nursing Practice Committee Date Effective: October 2002 Date Reaffirmed: January 2016 Scope: SHR Acute, Parkridge Centre Any PRINTED version of this document is only accurate up to the date of printing 30-May-16. Saskatoon Health Region (SHR) cannot guarantee the currency or accuracy of any printed policy. Always refer to the Policies and Procedures site for the most current versions of documents in effect. SHR accepts no responsibility for use of this material by any person or organization not associated with SHR. No part of this document may be reproduced in any form for publication without permission of SHR. 1. PURPOSE 1.1 To safely and effectively use Oropharyngeal Airway (OPA). 2. POLICY 2.1 The Registered Nurse (RN), Registered Psychiatric Nurse (RPN), Licensed Practical Nurse (LPN), Graduate Nurse (GN), Graduate Psychiatric Nurse (GPN), Graduate Licensed Practical Nurse (GLPN) will insert, maintain, suction and remove an oropharyngeal airway (OPA). 2.2 The OPA may be inserted to establish and assist in maintaining a patent airway. 2.3 An OPA should only be used in patients with decreased level of consciousness or decreased gag reflex. 2.4 Patients with OPAs that have been inserted for airway protection should not be left unattended due to risk of aspiration if gag reflex returns unexpectedly. Page 1 of 4 Policies and Procedures: Airway – Oropharyngeal: Insertion; Maintenance; I.D. # 1159 Suction; Removal 3. PROCEDURE 3.1 Equipment: • Oropharyngeal airway of appropriate size • Tongue blade (optional) • Clean gloves • Optional: suction equipment, bag-valve-mask device 3.2 Estimate the appropriate size of airway by aligning the tube on the side of the patient’s face parallel to the teeth and choosing an airway that extends from the ear lobe to the corner of the mouth. -
Scope of Practice Statements
Scope of Practice Statements Emergency Medical Services Authority California Health and Human Services Agency EMSA # 300 November 2017 HOWARD BACKER, MD, MPH, FACEP DIRECTOR DANIEL R. SMILEY CHIEF DEPUTY DIRECTOR SEAN TRASK DIVISION CHIEF EMSA # 300 Released November 2017 EMSA #300 • Page 1 Table of Contents Introduction ........................................................................................................................................... 4 The EMS Authority ................................................................................................................................ 4 Local EMS Agencies ............................................................................................................................. 4 California EMS Personnel Levels .......................................................................................................... 4 Reading the Scope of Practice Pages .................................................................................................. 5 Airway and Breathing ............................................................................................................................ 6 Airway Suctioning .............................................................................................................................. 7 Automatic Transport Ventilator .......................................................................................................... 8 Bag Valve Mask – BVM .................................................................................................................... -
Strategies to Support the COVID-19 Response in Lmics a Virtual Seminar Series Screening, Triage and Patient Flow
Strategies to support the COVID-19 response in LMICs A virtual seminar series Screening, Triage and Patient Flow Bhakti Hansoti, MBChB, MPH, PhD - Associate Professor in Emergency Medicine, Johns Hopkins University OBJECTIVES 1. Clinical Features 2. Preparing the Department 3. Initial Management 4. Other Management Considerations 5. Summary Clinical Features Severity • Most people with COVID-19 develop mild or uncomplicated illness • Approximately 14% develop severe disease requiring hospitalization and oxygen support • 5% require admission to an intensive care unit • In severe cases, COVID-19 can be complicated by • Acute respiratory disease syndrome (ARDS) • Sepsis and septic shock • Multiorgan failure, including acute kidney injury and cardiac injury. Preparing the Department Elements to be assessed have been divided into the following areas: • Establishment of a core team and key internal and external contact points • Human, material and facility capacity • Communication and data protection • Hand hygiene, personal protective equipment (PPE), and waste management • Triage, first contact and prioritization • Patient placement, moving of the patients in the facility, and visitor access • Environmental cleaning https://www.ecdc.europa.eu/en/publications-data/checklist- hospitals-preparing-reception-and-care-coronavirus-2019-covid-19 Split flow Protecting Yourself These videos can help with PPE donning and doffing technique: • Donning and doffing PPE https://www.youtube.com/watch?v=I94l IH8xXg8 • Recommended PPE during care https://www.youtube.com/watch?v=oPL -
High Performance CPR Update
High Performance CPR Update Page | 1 Final Revision 8/8/2012 As part of our ongoing Quality Assurance in Cardiac Arrest incidents, Skagit County EMS under the direction of Dr. Don Slack, MPD is making changes to the way that ALS and BLS providers perform CPR. Overview: CPR quality has a dramatic impact on pt survival when done according to these guidelines. Minimal breaks in compressions, full chest recoil, adequate compression depth and adequate compression rate are all components of CPR that an increase survival from sudden cardiac arrest. Together these components go together to create High Performance CPR (HP CPR). Roles: As a rule for the unconscious, unresponsive, pulseless patient the FIRST person to the patient starts compressions. SECOND person does defibrillation (If there are only 2 responders to begin with, ventilations should begin after the rhythm analysis and shock if indicated). THIRD person should start ventilating the patient, placing a King Airway as soon as is practical. A timekeeper needs to be assigned to ensure high quality CPR, minimal interruption and help track the ALS interventions. Principles of HP CPR 1. EMT’s own CPR!! 2. Minimize interruption in CPR at all times, use a timekeeper 3. Ensure proper depth of compressions (>2 inches) 4. Ensure full chest recoil/decompression 5. Ensure proper chest compression rate (100-120/min) 6. Rotate compressors at least every 2 minutes 7. Do not interrupt compressions to ventilate patient, even if an advanced airway is not placed 8. Hands off the chest only during analysis and shock delivery, hover hands over chest during shock delivery and be ready to resume compressions 9. -
Small Adult CPR-2 Bag with Litesaver Manometer Brochure
ORDERING INFORMATION Your Need ... Our Innovation® O Manometer 2 Detector 2 AerosolTubing Reservoir Infant Cushion Mask Expandable Large Bore Color-Coded Mask PEEP w/Filter StatCO Manometer LiteSaverTiming Light with CPR (Synthetic Rubber) CPR-2 (PVC) Light Blue Oxygen Bag Reservoir (22mm) Adult Cushion Mask SmallAdult Cushion Mask with Flange #3 Pediatric Cushion Mask Child Cushion Mask PEEP Valve Pop-Off Dark Blue Oxygen Reservoir 0-60 cm H PART # OTHER #10-56402 X X X X X X #10-56403 X X X X #10-56404 X X X X X #10-56411 X X X X #10-56412 X X X X X #10-56423 X X X X X X #10-56424 X X X X X X CPR-2 Small Adult Bag with Manometer #10-56432 X X X X X #10-56435 X X X X X X X #10-56437 X X X X #10-56438 X X X X X #10-56440 X X X X #10-58500 X X X X #10-58501 X X X X X #10-58502 X X X X X #10-58503 X X X X X X #10-58506 X X X X X X #10-58507 X X X X X #10-58509 X X X X X #10-58512 X X X X X X X #10-55901 X X X #10-55904 X X X #10-55907 X X X #10-55909 X X X X #10-55910 X X X X #10-55912 X X X #10-55913 X X X X X X No lock clip #10-55915 X X X X X #10-55916 X X X #10-55917 X X X X X #10-55918 X X X X X X #10-55922 X X X X X X X #10-55923 X X X X #10-55924 X X X X X #10-55928 X X X #10-58400 X X X X #10-55365 LiteSaver Manometer Assy 20/Box 0-60 cm H2O, Adult Frequency 10 BPM #10-55366 LiteSaver Manometer Assy 20/Box Assembly 0-60 cm H2O In-Line Tee Right Orientation, Adult Frequency 10 BPM #10-55367 LiteSaver Manometer Assy 20/Box Assembly 0-60 cm H2O In-Line Tee Left Orientation, Adult Frequency 10 BPM = CPR-2 Small Adult Bags *References Can EMS Providers Provide Appropriate Tidal Volumes in a Simulated Adult-sized Patient with a Pediatric-sized Bag-Valve-Mask? Journal Pre-hospital Emergency Care, Volume 21, 2017, Issue 1, Jeffery Siegler, MD, EMT-P, Melissa Kroll, MD, Susan Wojcik, PhD, ATC & Hawnwan Philip May, MD Avoid Airway Catastrophes on the Extremes of Minute Ventilation, Acepnow.com, January 20, 2015, Richard M. -
ABBREVIATION LIST ALOC Altered Level of Consciousness ABC's Airway, Breathing, Circulation ACLS Advanced Cardiac Life Suppo
ABBREVIATION LIST ALOC Altered Level of Consciousness ABC’s Airway, Breathing, Circulation ACLS Advanced Cardiac Life Support AED Automatic External Defibrillator AICD Automatic Implantable Cardiac Defibrillator ALS Advanced Life Support AMI Acute Myocardial Infarction AMS Altered Mental Status AMR American Medical Response ASA Aspirin AV Atrial Ventricular BHPC Base Hospital Physician Contact BLS Basic Life Support BP Blood Pressure bpm Beats Per Minute BSI Body Substance Isolation BVM Bag Valve Mask CaCl Calcium Chloride CC Chief Complaint C-spine Cervical Spine CHF Congestive Heart Failure COPD Chronic Obstructive Pulmonary Edema CPR Cardiopulmonary Resuscitation CVA Cerebral Vascular Accident D12.5%W Dextrose 12.5% in water D50%W Dextrose 50% in water DKA Diabetic Ketoacidosis DM Diabetes Mellitus DNR Do Not Resuscitate ED Emergency Department EKG Electrocardiogram EMS Emergency Medical Services Epi Epinephrine ET Endotracheal Tube ETT Endotracheal Tube gm Gram GCS Glasgow Coma Scale HazMat Hazardous Materials HEENT Head, Eyes, Ears, Nose, Throat HTN Hypertension IO Interosseous IM Intramuscular ITLS International Trauma Life Support IV Intravenous IVP Intravenous Push (IV push prefed) kg Kilogram San Mateo County EMS Agency Introduction Abbreviation List 2008 Page 1 of 3 J Joule LOC Loss of Consciousness Max Maximum mcg Microgram meds Medication mEq Milliequivalent min Minute mg Milligram MI Myocardial Infarction mL Milliliter MVC Motor Vehicle Collision NPA Nasopharyngeal Airway NPO Nothing Per Mouth NS Normal Saline NT Nasal Tube NTG Nitroglycerine NS Normal Saline O2 Oxygen OB Obstetrical OD Overdose OPA Oropharyngeal Airway OPQRST Onset, Provoked, Quality, Region and Radiation, Severity, Time OTC Over the Counter PAC Premature Atrial Contraction PALS Pediatric Advanced Life Support PEA Pulseless Electrical Activity PHTLS Prehospital Trauma Life Support PID Pelvic Inflammatory Disease PO By Mouth Pt. -
Importance of Validation Risk Prediction Tools
Art: toc Input-citi 22:40 12/2/7 12؍balt6/z7i-anesth/z7i-anesth/z7i00812/contents panickes S ON THE COVER: David Mackey, M.D., has organized a fascinating series of commentaries by national leaders In this issue of ANESTHESIOLOGY, two original research articles and three editorial views examine in the construction and use of clinical data registries by regulatory agencies and physician the use of data in clinical decision making. practices, the first two of which appear in this month’s issue: ● Kheterpal et al.: Impact of a Novel Multiparameter Decision Support System on Intraoperative ● Mackey: Can We Finally Conquer the Problem of Medical Quality? The Systems-based Processes of Care and Postoperative Outcomes, p. 272 Opportunities of Data Registries and Medical Teamwork, p. 225 ● Liu et al.: Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac ● Jain et al.: A Public-Private Strategy to Advance the Use of Clinical Registries, p. 227 Risk Assessments, p. 283 Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/128/2/A1/364553/20180200_0-00001.pdf by guest on 01 October 2021 ● Sessler: Decision Support Alerts: Importance of Validation, p. 241 ● Glance et al.: Risk Prediction Tools: The Need for Greater Transparency, p. 244 ● Javitt: Regulatory Landscape for Clinical Decision Support Technology, p. 247 ᭛ THIS MONTH IN ANESTHESIOLOGY 9A ᭛◆ THISEDITORIAL MONTH VIEWS IN ANESTHESIOLOGY 1A . Can We Finally Conquer the Problem of Medical Quality? The Systems-based ◼ SCIENCE, MEDICINE, AND THE ANESTHESIOLOGIST 15A Opportunities of Data Registries and Medical Teamwork 225 David C. Mackey ◼ INFOGRAPHICS IN ANESTHESIOLOGY 19A . A Public-Private Strategy to Advance the Use of Clinical Registries 227 Sachin H. -
Paramedic Airway Management Course
Pierce County EMS Paramedic Airway Course 2nd Edition September 2012 Pierce County EMS Paramedic Airway Management Course Table of Contents: Acknowledgements ............................................................................................ 3 Course Purpose and Description ..................................................................... 4 Background ........................................................................................................ 5 Assessing the Need for Emergency Airway Management ............................. 6 Effective Use of the Bag-Valve Mask ............................................................... 7 Endotracheal Intubation—Preparing for First Pass Success ........................ 8 RSI & Endotracheal Intubation ....................................................................... 11 Confirming, Securing and Monitoring Airway Placement ............................ 15 Use of Alternative “Rescue Airways” ............................................................ 16 Surgical Airways .............................................................................................. 17 Emergency Airway Management in Special Populations: ........................... 18 Pediatric Patients Geriatric Patients Trauma Patients Bariatric Patients Pregnant Patients Ten Tips for Best Practices in Emergency Airway Management ................ 21 Airway Performance Documentation and CQI Analysis ............................... 22 Conclusion ...................................................................................................... -
Mapping the Use of Simulation in Prehospital Care – a Literature Review Anna Abelsson1*, Ingrid Rystedt1, Björn-Ove Suserud2 and Lillemor Lindwall1
Abelsson et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:22 http://www.sjtrem.com/content/22/1/22 REVIEW Open Access Mapping the use of simulation in prehospital care – a literature review Anna Abelsson1*, Ingrid Rystedt1, Björn-Ove Suserud2 and Lillemor Lindwall1 Abstract Background: High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. Methods: An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. Results: The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. -
Resuscitation and Defibrillation
AARC GUIDELINE: RESUSCITATION AND DEFIBRILLATION AARC Clinical Practice Guideline Resuscitation and Defibrillation in the Health Care Setting— 2004 Revision & Update RAD 1.0 PROCEDURE: signs, level of consciousness, and blood gas val- Recognition of signs suggesting the possibility ues—included in those conditions are or the presence of cardiopulmonary arrest, initia- 4.1 Airway obstruction—partial or complete tion of resuscitation, and therapeutic use of de- 4.2 Acute myocardial infarction with cardio- fibrillation in adults. dynamic instability 4.3 Life-threatening dysrhythmias RAD 2.0 DESCRIPTION/DEFINITION: 4.4 Hypovolemic shock Resuscitation in the health care setting for the 4.5 Severe infections purpose of this guideline encompasses all care 4.6 Spinal cord or head injury necessary to deal with sudden and often life- 4.7 Drug overdose threatening events affecting the cardiopul- 4.8 Pulmonary edema monary system, and involves the identification, 4.9 Anaphylaxis assessment, and treatment of patients in danger 4.10 Pulmonary embolus of or in frank arrest, including the high-risk de- 4.11 Smoke inhalation livery patient. This includes (1) alerting the re- 4.12 Defibrillation is indicated when cardiac suscitation team and the managing physician; (2) arrest results in or is due to ventricular fibril- using adjunctive equipment and special tech- lation.1-5 niques for establishing, maintaining, and moni- 4.13 Pulseless ventricular tachycardia toring effective ventilation and circulation; (3) monitoring the electrocardiograph and recogniz-